The Centers for Disease Control released an additional update on the status of its cyclospora outbreak investigation on Tuesday evening. The CDC website, along with press releases from Nebraska’s Department of Health and Human Services, or DHHS, and Iowa’s Department of Public Health, or IDPH, implicate a prepackaged salad mix as the source of the outbreak in those two states.

“Our investigation implicated prepackaged, prewashed salad mix as the cause of this outbreak,” Dr. Joseph Acierno, Chief Medical Officer and Director of Public Health for the Nebraska DHHS, said.

According to the Nebraska DHHS press release, the salad mix, which went through national distribution channels, included iceberg and romaine lettuce, red cabbage and carrots. “Locally grown produce is not part of this outbreak,” the release stated.

The Nebraska DHHS, along with local health departments and the U.S. Food and Drug Administration, are continuing to investigate where the contamination occurred along the production chain and where the mixed salad product was distributed.

According to the Nebraska DHHS press release, "Nebraska public health officials believe the bulk of the contaminated salad mix has already worked its way through the system due to limited shelf life.”

Steven Mandernach, chief of the Food and Consumer Safety Bureau in Iowa, shared a similar position: “Iowans should continue eating salads, as the implicated prepackaged mix is no longer in the state’s food supply chain.”

According to the CDC report released Tuesday, more than 372 cases of cyclospora infections have been reported in several states and one city, including Iowa, Nebraska, Texas, Wisconsin, Georgia, Missouri, Arkansas, Connecticut, New Jersey, Minnesota, Ohio, Florida and New York City. Illinois, Missouri and New York are reporting one case each that was likely acquired out of state, with Kansas reporting two cases that were possibly acquired out of state.

According to the report, Iowa has the most reported cyclospora infections with 143 cases, followed by Texas with 101 cases and Nebraska with 76 cases.

Cyclospora, a single-celled parasite, causes an intestinal infection called cyclosporiasis, marked by symptoms such as diarrhea, stomach cramps, nausea and fatigue, among other symptoms of stomach bugs.

Cyclospora infections tend to occur in people living in or traveling to the tropics and subtropic regions, where the parasite is endemic. It is usually spread when people ingest food or water contaminated with feces.

At least 21 people have been reportedly hospitalized in three states as a result of the outbreak.

The CDC continues to cooperate with FDA and public health officials across multiple states to aid in the investigation of the source of the outbreak in those states.

The CDC defines outbreak cases as “laboratory-confirmed Cyclospora [infections] in [people] who became ill in June or July 2013 and had no history of travel outside of the United States or Canada during the 14 days prior to onset of illness.”

More cases are currently under investigation and will be published on the CDC website as they are confirmed. Out of all the cases, 34 have been confirmed in CDC laboratories.

The CDC and FDA advise the public to practice safe food handling, including thoroughly washing produce and hands to prevent a cyclospora infection. The avoidance of food or water contaminated with feces is also advised.